Endodontic microsurgery outcomes over 10 years and associated prognostic factors: a retrospective cohort study.

INTRODUCTION: This retrospective cohort study aimed to evaluate long-term healing outcomes (10-17.5 years) following contemporary endodontic microsurgery (EMS) and identify associated prognostic factors. METHODS: Clinical and radiographic data of an EMS cohort (2006-2013) from the electronic data base of Dental Hospital were reviewed retrospectively by two independent examiners to determine their survival and healing outcomes, and potential prognostic factors analyzed by Cox proportional hazards regression and logistic regression (α = 0.05). RESULTS: Through strict inclusion and exclusion criteria, and 721 EMS-treated teeth in the cohort, 309 (42.9%) were included (male, 35.0%; female, 65.0%; age, 45.83 ± 15.53 years) with mean final follow-up of 152.26 ± 26.37 months (range, 120-211; median, 148). Clinical and radiographic assessments found 80.5% of 10 years survival rate with 63.4% of success. Collectively, tooth type, tooth mobility, preoperative lesion size, clinical crown-root ratio, and crown restorations at follow-up were significantly associated with long-term success and survival over 10 years. CONCLUSIONS: The preoperative status and condition of the tooth including its alveolar bone support, and adequate full crown restorations may be relevant prognostic determinants of success and survival following EMS over time.

The effect of ultrasonic and multisonic irrigation on root canal microbial communities: An ex vivo study.

AIM: To analyse the effect of ultrasonic irrigant activation (UIA) and the GentleWave (GW) multisonic irrigation (GW) with minimal instrumentation on the root canal microbial diversity in an ex vivo model that used extracted molars with a history of pulp necrosis. METHODOLOGY: Twenty-three mandibular molars were prepared ex vivo for collection of superficial (surface control), pre-treatment and post-treatment samples 24 h after extraction. Samples were divided into two groups: UIA using 6% NaOCl (n = 11) and GW group (n = 12). All samples were processed using quantitative real-time polymerase chain reaction (qPCR) and 16S rRNA next-generation sequencing to measure microbial diversity before and after the antimicrobial treatment. For qPCR, a t-test (α = .05) was used to compare the log10 reduction. The Chao1 and Shannon indices evaluated alpha diversity. Differences in community composition (beta diversity) were evaluated by analysis of similarity (ANOSIM). Kruskal-Wallis test with Bonferroni corrections was performed to evaluate the differences in abundances genera in the samples. RESULTS: Quantitative real-time polymerase chain reaction revealed an estimated 1.6 and 2.6 log10 reduction for UIA and GW groups respectively (p = .048). An average of 5 ± 4 and 3 ± 5 operational taxonomic units (OTUs) were found in surface's samples in the UIA and GW group respectively. These values were significantly lower (p < .001) compared to the number of preoperative OTUs in those groups (155 ± 79 and 187 ± 121). In assessing beta diversity, there were no significant differences found in pre-treatment samples (R = .090, p = .070 ANOSIM with Bonferroni corrections). Also, no significant differences in community composition were observed in post-treatment samples (R = -.05, p = .829). After treatment, there was a significant reduction of Eubacterium using conventional treatment with UIA and a significant reduction of Prevotella using minimal instrumentation with GW irrigation (p = .007 and p = .002 respectively). CONCLUSION: Quantitative PCR analysis revealed a significant reduction in microbial load for GW group. Overall, diversity changes were similar between UIA and GW irrigation in this ex vivo model that used extracted teeth with a history of pulp necrosis. OTUs obtained from the surface sample were negligible and did not affect the statistical outcome of the study.

Present status and future directions of intracanal medicaments.

Two fundamental goals of endodontic treatment are to prevent or treat apical periodontitis. From a predictive perspective, several variables can affect the outcome of root canal treatment. Some of these variables depend on intraoperative factors, which include irrigation technique, size of the apical preparation, use of intracanal medicaments or the number of appointments necessary to complete the treatment. However, the outcome may also be affected by host and microbial factors. The intensity of periradicular bone loss or tissue damage, the presence of preoperative pain and associated conditions such as mechanical allodynia and central sensitization, the anatomical complexity of the apical portion of the canal, and the virulence and longevity of the bacterial infection can all have a profound influence on the outcome. Furthermore, numerous medical conditions have been reported to decrease the capability of the immune system to heal the periapical tissues. It is the clinician's responsibility to analyse these variables and incorporate them into the disinfection strategy to maximize the chances of healing. This narrative review will focus on the present status of intracanal medicaments, the clinical indications for their use and future directions for research.

A novel approach in assessment of coronal leakage of intraorifice barriers: a saliva leakage and micro-computed tomographic evaluation.

The efficacy of amalgam, Fuji-Plus, Geristore, and mineral trioxide aggregate (MTA) as intraorifice barriers was compared in a simulated saliva leakage model. Fifty teeth were divided into 4 experimental (n = 10 each) and 2 control groups (n = 5 each). Two millimeters of the materials was placed as intraorifice barriers and brought into contact with human saliva in a coronal reservoir. Bacterial leakage into the apical reservoir was assessed daily for 3 months. Geristore barriers leaked significantly more often (5/10) than Fuji-Plus (0/10, P < .05) at 60 days. The first Fuji-Plus sample leaked after 70 days; after 90 days, 3 (Fuji-Plus), 4 (MTA, amalgam), and 6 (Geristore) samples leaked. There were no significant differences between the experimental groups at that time point. Three-dimensional gap volumes in the barrier-dentin interface and the porosity of the barrier materials were compared by using micro-computed tomography (microCT). A measurable gap was evident in only 1 specimen with an MTA barrier. MTA was significantly less porous than Fuji-Plus and Geristore (P < or = .05), whereas amalgam was too radiopaque to allow microCT measurements. In conclusion, Fuji-Plus might be an effective intraorifice barrier (up to 70 days in vitro), but all 4 materials showed leakage in some specimens at 90 days.